August 22, 2013
COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Program
Hospital Management, HCA 536
Fall, 2013
Instructor: Richard L. Tradewell, MBA, Ph.D.
E-mail: richard.tradewell@csulb.edu
Office Hours: TBA
Phone: (562) 985-5694 Office
(949) 400-0960 Cell (text for meeting)
Class Number: 9180
Class Meets: Monday 7-9:45pm
Location: Room: SPA 006
HCA Program Administrative Coordinator:
Deby McGill deby.mcgill@csulb.edu
Catalog Description
Analysis of hospitals by broad function and specific departments through cases, simulations and
visits to develop familiarity with internal operations of acute care hospitals and skills in solving
hospital operational problems. Prerequisite: HCA 505.
Course Description
Focus on controversial place of hospitals within the context of health care policy reform and the
hospital’s changing role within integrated care systems. Several case studies will be used to
provide students with a real world simulation of strategic, operational, legal and image problems
confronting hospitals today.
Expected Learning Objectives & Outcomes; Activities, Assignments & Assessments. The
Health Care Administration Department has adopted a competency-based curriculum, based on
the American College of Health Care Executives (ACHE) Competencies Assessment Tool and
the Healthcare Leadership Alliance (HLA) Competency Directory.
Focus is on acquiring competencies in the following Domains:




Domain 1: Communication and Relationship Management
Domain 2: Leadership
Domain 4: Knowledge of the Healthcare Environment
Domain 5: Business Knowledge and Skills
o Domain 5B: Business Knowledge and Skills: Human Resources
o Domain 5C: Business Knowledge and Skills: Organizational Dynamics and Governance
o Domain 5D: Business Knowledge and Skills: Strategic Planning and Marketing
o Domain 5E: Business Knowledge and Skills: Information Management
o Domain 5F: Business Knowledge and Skills: Risk Management
o Domain 5G: Business Knowledge and Skills: Quality Improvement
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Alignment of the expected outcomes and the ACHE and HLA competencies provides clear
expectations and standards for students and instructors alike. Students will demonstrate a level of
proficiency in each of the expected outcomes through the course assignments as indicated in the
following table.
Learning Objective
Domain
Competency – Knowledge
of

How does employee
relations, especially
nursing, recruitment,
training, and retention,
relate to hospital
competitive advantage?
5. B


Understand the changing
role and legal
responsibilities of the
executive office, including
the hospital board of
directors and medical staff.
Understand principles of
effective communication.
Understand effective
hospital CEO leadership.
5. C

Compare/contrast
advantages and
disadvantages of the three
institutional and legal
forms: for-profit, nonprofit, and government
operated hospitals.
5.C.



1.

2.




Nursing shortage,
staffing regulations,
wage issues, training and
development in support
of hospital culture, role
on treatment team;
promotion opportunities.
Board of Trustee
selection, relationship of
board to CEO and
medical staff, Peter
Drucker’s criteria for an
effective board.
Communication and
Relationship
Management
CEO Leadership
evaluation criteria
Understand regulatory
requirements of the
501C(3) or public benefit
corporation.
Evaluate impact of
government payments on
charity obligations.
Compare value of tax
payments by for-profit
hospitals with tax support
of government hospitals.
Activity (A1),
Assignment (A2) or
Assessment (A3)
Case studies; take
home exams.
Graded case analysis.
Kovner Case P,
“Whose Hospital?”
used as study of CEO
fired by board. Class
discussion of board and
CEO mistakes.
Interview of CEO or
board member at local
hospitals.
Graded case analysis of
King-Drew Medical
Center as an example
government failure.
Take home midterm
exam covering Wall
Street Journal and
Health Affairs studies.
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

Identify methods of
measuring performance
outcomes.
5.G.

Discuss the function of the
Organized Medical Staff.
5.C.
Analyze effectiveness of
several emerging models of
physician leadership.

Negotiate the complexities
of outsourcing hospital
services.
5.C.
Where outsourcing works in
hospitals and where it does
not. Selecting a model.
Use IT to significantly
increase the effectiveness
and reduce the costs of
hospital operation.
5.E.

Develop competency in
selecting performance
measures and skill in
monitoring variance from
targets.
Analyze cost and benefits of
hospital electronic medical
records as a control
mechanism.
Take home midterm
exam.
Graded case analysis.
Harvard Case Study,
Cincinnati Children’s
Hospital, presented as a
model for development
of techniques and
culture for measuring
outcomes.
Graded case analysis of
Kovner Case J,
“Physician Leadership:
MetroHealth System of
Cleveland.”
Final take home exam.
Answering questions
from Tradewell’s
“Privatizing Public
Hospitals” Reason
Foundation.
Graded case analysis:
“Electronic Medical
Records System
Implementation at
Stanford Hospital and
Clinics.” Stanford
Business School.
Methods of Presentation: the class is organized as a discussion seminar. Instructor posts a
weekly PowerPoint and case study on BeachBoard to guide discussion. Students will read and
answer questions on a different case each week to order to discuss and share solutions in class.
Use of Academic Technology in this Class
This course makes use of several forms of academic technology, including the web, e-reserves
and BeachBoard. Students are required to use of this technology to fulfill the requirements for
this course. To participate in the academic technology elements of this course, students must
have access to, and be able to use:



A computer, equipped with Adobe Acrobat Reader 5.0 or newer and word-processing
software capable of reading Microsoft Word XP files.
The internet. Specifically, the World Wide Web. Whatever internet service provider is
used must be capable of accessing Web pages, BeachBoard and Acrobat files.
An account on BeachBoard.
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August 22, 2013
Student Responsibilities and University Policies
(1) CSULB policies on cheating and plagiarism shall apply, as delineated in California State
University, Long Beach Policy Statement 85-19, December 13, 1985. One or more of the
following academic actions are available to the faculty member who finds a student has been
cheating or plagiarizing.
(a) Review—no action.
(b) An oral reprimand with emphasis on counseling toward prevention of further
occurrences;
(c) A requirement that the work be repeated;
(d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting
in the proportional reduction of final course grade;
(e) Assignment of a failing final grade;
(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion.
(2) Students who need accommodation for any type of disability must inform the instructor in
advance.
(3) Withdawal is the responsibility of student. Withdrawal after the posted date is allowed only
for serious and compelling reasons and requires the approval of the dean.
(4) Absences are excused consistent with University policies.
(5) Students are expected to have CSULB email accounts and to check their email and
BeachBoard regularly for class announcements.
Methods of Evaluation
Quizzes: 5 @ 10 points each
Final exam
Answering Instructor questions from readings (See Dropbox)
Short case analysis papers (6 cases @ 5% each to Dropbox)
50
50
20
30
Harvard Case Study: “Cincinnati Children’s Hospital Medical Center”
20
Virginia Mason Medical Center Transformation (Health Affairs, book, articles)
OR
Harvard Case Study: “Hospital for Special Surgery”
20
Discussion from Hospital Field Trips
Total
Grading
90 % and higher:
80 % and higher
70 % and higher
60 % and higher
10
200
A
B
C
D
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August 22, 2013
Below 60%
F
Texts:
1. Required:
Griffin, Don. 2012. Hospitals: What They Are and How They Work. Fourth Edition. Boston:
Jones and Barlett.
Kovner, McAlearney, Neuhauser. 2009. Health Services Management: Cases, Readings, and
Commentary. Ninth Edition. AUPHA.
2. Provided by instructor on Beachboard:
http://economix.blogs.nytimes.com/2013/03/01/shocked-shocked-over-hospitalbills/?_r=0&pagewanted=print
http://www.washingtonpost.com/blogs/wonkblog/post/americas-hospital-infections-problemin-one-very-long-graphic/2011/08/25/gIQAqzGTuJ_blog.html
http://www.6sigma.us/six-sigma-healthcare.php?gclid=CIuYp4LhgLkCFZF7QgodmgsAPQ
United HealthCare Hospital Comparison Program
https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=cf7f98675415e010V
gnVCM100000c520720a____
Altman, Stuart H., et.al. 2006. “Could U.S. Hospitals Go the Way of Airlines? Health
Affairs, Vol 25, No. 1. Jan/Feb. 2006.
“A Model Health Care Delivery System for Medicaid”
Richard E. Rieselbach, M.D., and Arthur L. Kellermann, M.D., M.P.H. New England Journal
of Medicine. June 1, 2011.
“Managed Competition for Medicare? Sobering Lessons from the Netherlands” Kieke G.H.
Okma, Ph.D., Theodore R. Marmor, Ph.D., and Jonathan Oberlander, Ph.D. New England
Journal of Medicine. June 15, 2011.
Brink, Susan. March 6, 2006. “And Now, Four Star Hospitals” in Los Angeles Times.
Dentzer, Susan Still Crossing The Quality Chasm—Or Suspended Over It? Health Affairs.
April 2011 30:554-555; doi:10.1377/hlthaff.2011.0287
Kovner, Anthony R. and Duncan Neuhauser. 2004. Health Services Management: Readings,
Cases, and Commentary. Eighth Edition. AUPHA Press. (Provided as e-reserve by
instructor)
Halpin, Helen A., Arnold Milstein, Stephen M. Shortell, Megan Vanneman and Jon
Rosenberg. 2011. Mandatory Public Reporting Of Hospital-Acquired Infection Rates: A
Report From California Health Affairs, 30, no.4 (2011):723-729
Mark McClellan, Aaron N. McKethan, Julie L. Lewis, Joachim Roski, and Elliott S. Fisher
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A National Strategy To Put Accountable Care Into Practice
HEALTH AFFAIRS 29, NO. 5, May (2010): 982–990
Classen David C., et al. 2011. Global Trigger Tool’ Shows That Adverse Events In Hospitals
May Be Ten Times Greater Than Previously Measured aaHealth Aff April 2011 30:581-589;
doi:10.1377/hlthaff.2011.0190
Goldsmith, Jeff. 2011. “Accountable Care Organizations: The Case For Flexible Partnerships
Between Health Plans And Providers” HEALTH AFFAIRS 30, NO. 1 (2011): 32–40
Herzlinger, Regina E. “Hospital for Special Surgery,” Harvard Business School, Case Study
9-305-076, August 17, 2005 (Provided as e-reserve by instructor).
Herzlinger, Regina. E. 2007. Who Killed Health Care? America’s $2 Trillion Medical
Problem and the Consumer-Driven Cure. New York: McGraw-Hill. (Entire book is useful;
we will use Chapter 3, “The General Hospitals” on e-reserves with a pdf file posted on
BeachBoard).
Lee, Fred. 2004. If Disney Ran Your Hospital. Bozeman, MT: Second River Healthcare
Press. (Two chapters in e-reserves).
RTI International. August 27, 2010. “U.S. News and World Report 2010/11 Best Hospitals
Ranking Methodology.”
Tradewell, Richard L. “Privatizing Public Hospitals: Strategic Options Policy in an Era of
Industry-wide Consolidation.” Study No. 242, April 1998. Reason Foundation.
Weber, Tracy, Charles Ornstein and Mitchell Landsberg. “Deadly Errors and Politics Betray
a Hospital’s Promise.” Los Angeles Times. December 5, 2004. All seven parts of the Los
Angeles Times Pulitzer-prize series of articles documenting failure at King Drew Medical
Center are on Beach Board.
Weimer, David L. and Aidan R. Vining. 2005. Chapter 8: “Limits to Public Intervention:
Government Failures” in Policy Analysis: Concepts and Practice. Prentice Hall.
A wide variety of additional Health Affairs articles and other materials are identified in
weekly reading assignments.
3. Note on background preparation:
This class is conducted as a graduate seminar in hospital management. If the student has
not had an introductory class in health care administration that covered hospital history and
development of hospitals in the U.S., it is strongly recommended that any good text be used
for this purpose:
a. Shi & Singh. 2004. Delivering Health Care in America, Chapter 8. A PowerPoint
for this chapter is on BeachBoard Documents.
b. Raffel, et.al. 2002. The U.S. Healthcare System. Chapter 7.
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Useful websites:
Health Facilities Management http://www.hfmmagazine.com/hfmmagazine_app/index.jsp
Agency for Healthcare Research and Quality
http://www.ahrq.gov/
Healthcare Financial Management Association
http://www.hfma.org/
The Healthcare Information and Management Systems Society (HIMSS)
http://www.himss.org/ASP/index.asp
American College of Healthcare Executives
http://www.ache.org/
Centers for Medicare and Medicaid Servics
http://www.cms.hhs.gov/
Joint Commission on Accreditation of Healthcare Organizations
http://www.jointcommission.org/
Joint Commission’s Report: Improving America’s Hospitals
http://www.jointcommissionreport.org/
RAND
http://www.rand.org/
Robert wood Johnson Foundation
http://www.rwjf.org/
National Center for Policy Analysis
http://www.ncpa.org/pub/st/st296/st296.pdf (Why you do not know the price of your medical
service).
http://sicko.ncpa.org/?c=reviews (Michael Moore alternatives)
Health Grades (examples of reports on hospitals):
http://www.healthgrades.com/consumer/index.cfm?fuseaction=modnw&modtype=content&mod
act=SHOP_HospQual_Example (fee)
http://www.healthgrades.com/consumer/index.cfm?fuseaction=mod&modtype=hospitals&moda
ct=hospitals_search_results&prodtype=hosprat&state=CA&city=&maparea=&proc=&tabset=ps
a&hgid=&useragree=yes (CA hospital safety rankings: free to public).
Schedule of Classes
Week 1
Orientation; introductory remarks
Lecture and discussion
FOCUS AREA: WHY ARE HOSPITALS THE TARGET OF PUBLIC CRITICISM?
Text Reading Assignment:
Herzlinger, 2007 “Chapter 3 The General Hospital: Death at the Hands of the Empire Builders”
in Who Killed Health Care? (e-reserves and BeachBoard).
Wall Street Journal article on Non-profit hospitals
Altman, Stuart H., et.al. 2006. “Could U.S. Hospitals Go the Way of Airlines? Health Affairs,
Vol 25, No. 1. Jan/Feb. 2006.
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August 22, 2013
Goldhill’s “Killed” http://www.theatlantic.com/magazine/archive/2009/09/how-american-healthcare-killed-my-father/307617/
Discussion questions:
1. What sources does Herzlinger use in her recent book to convince readers that U.S.
hospitals are low quality and high cost?
2. How do nonprofit hospitals (supposedly tax exempt to serve the community interest)
stifle innovation and efficiency through efforts to restrict competition?
3. Why is Herzlinger skeptical that vertical integration leads to better health care?
4. Why does Herzlinger believe no Sam Walton (WalMart) has arisen to save hospitals?
5. What does she think of specialty hospitals? Of global competition in hospital services?
6. What are the major problems in comparing hospitals to airlines?
7. What does Brill’s “Bitter Medicine” say about hospitals?
8. Why does Conover challenge Brill with creating myths?
9. What does Goldhill “Killed My Father” say about hospitals?
Week 2
Campus closed Sep 2, Labor Day
Week 3
Lecture: How are hospitals governed?
FOCUS AREA: THE UNIQUE CHALLENGES OF HOSPITAL ORGANIZATION
Griffin: Chapters 1-3.
A Drucker classic: Chapter 52. “Needed: An Effective Board”
Case 14 in Kovner: “Whose Hospital?”
Discussion:
1. Do hospitals have a unity of command problem? Can a hospital CEO fire a bad surgeon
(dangerously incompetent or performing excessive surgery)?
2. What are the qualifications of members of a community hospital board? Are the board
members in Case 14 typical?
3. Who/what is ultimately responsible under case law for patient mistakes in hospitals?
4. Should hospitals be reorganized to allow CEO full unity of control powers?
5. Should doctors be hospital employees?
http://video.foxnews.com/v/2608920118001/obamacares-impact-more-doctors-becominghospital-employees/
http://www.forbes.com/sites/scottgottlieb/2013/03/15/hospitals-are-going-on-a-doctorbuying-binge-and-it-is-likely-to-end-badly/
http://online.wsj.com/article/SB10001424127887323628804578346614033833092.html?mo
d=WSJ_Opinion_LEADTop (Your doctor has clocked out).
Week 4
Finance
FOCUS AREA: ARE CONSUMERS GETTING POOR VALUE FOR MONEY FROM
HOSPITALS? WHY ARE HOSPITALS IN U.S. SO MUCH MORE PRICEY THAN EUROPE
AND JAPAN?
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“Bitter Pill: Why Medical Bills Are Killing Us” By Steven Brill Monday, Mar. 04, 2013. The entire
issue of Time magazine carried this single story.
http://www.time.com/time/magazine/article/0,9171,2136864,00.html#ixzz2cqgdb4U7
Forbes columnist, Chris Conover, thanks Brill for his gift to consumers but then painstakingly
explorers the myths in a two part article.
http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-healthcosts-part-1/2/
http://www.forbes.com/sites/chrisconover/2013/03/07/5-myths-in-steven-brills-bitter-pill-part2/print/
http://www.nationalreview.com/agenda/341951/guest-post-oren-cass-what-steven-brill-getswrong-us-health-care-costs-reihan-salam
Two Health Affairs articles compare and contrast current understanding of cost shifting.
Discussion:
1. Is cost shifting, or private insurers carrying the higher burden for a government that
purposely underpays for care, a reason why prices in the U.S. are so high? Do hospitals
set prices far above the cost of providing care so they can overbill the privates and selfinsured?
2. How big a factor in overcharging is the high percentage of uninsured patients that are
admitted through the emergency room?
Week 5
Lecture: Hospitals from a consumer’s point of view
Case 13 in Kovner: “A Personal Memorandum on Hospital Experience.”
Lee: Chapter 1 and Chapter 5 in If Disney Ran Your Hospital.
Reinhardt: “Pricing of Hospital Services: Chaos Behind a Veil of Secrecy”
Discussion:
1. How do hospitals treat patients? Do hospitals seeks competitive advantage in the area of
customer service/
2. Where does the hospital communication and service in Case 13 break down? How much
of the problem is designed into the way hospitals are built?
3. What departments of the hospital are most critical to customer service?
4. What are “silos” in an organization? How does Lee suggest dismantling them?
5. Why is hospital pricing so difficult to understand?
6. Do hospitals compete on price?
FOCUS AREA: THE ROLE OF THE HOSPITAL MANAGER
Week 5
Lecture: Can managers be trained to make good decisions?
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August 22, 2013
Kovner: pp 3-34. “Evidence-Based Management Reconsidered.”
Drucker: Chapter 37, “The Effective Decision” in Management: Tasks Responsibilities and
Practices (in e-reserves and on BeachBoard).
Case A: “A New Faculty Practice for the Department of Medicine
Case B: “The Associate Director and the Controllers”
Case C: “Now What?”
FOCUS AREA: CONTROL
Patrice L. Spath: “Taming the Measurement Monster” in Kovner, Part II, Control, pp. 89-105.
Griffin, answer questions 5-9 on page 334.
Week 6
Lecture: Measuring Performance
Case D: Ann Scheck McAlearney:“An Information Technology Implementation Challenge.”
Case E: Anthony R. Kovner: “Improving Financial Performance in the Orthopedic Unit.”
Case F: Cynthia Struk: Evidence-Based Quality Management in a Home Health Organization.”
“Electronic Medical Records System Implementation at Stanford Hospital and Clinics.” Stanford
Business School
Case from LA Times seven article investigative journalism series:
Article 1: “Deadly Errors” through Article 7: “Wrong Drug”
Discussion:
1. What were the warning signs that King-Drew was not performing?
2. How does the selection of performance measurements affect direction and outcome?
3. How do you know when you are measuring the wrong things?
Healthcare Financial Management Association: “Key Strategies for Sustained Performance
Improvement.” (on BeachBoard or
http://www.hfma.org/library/revenue/performancemanagement/Key_Strategies_Performance_Im
prove.htm .
10/10 Lecture: Quality and Safety: Evaluating Care
Reading Assignment: Griffin, Chapter 19-24
100K Lives Campaign
Griffin, Case 1, “Towel? What Towel?”
Griffin Case 6: “The Case of Jill”
Discussion:
1. What is ORYX?
2. What is the100k lives campaign?
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August 22, 2013
Review: discuss midterm study guide
FOCUS AREA: ORGANIZATIONAL DESIGN
10/17 Lecture/ Organizational Design for Effectiveness
Commentary: Understanding Organizations, pp. 151-158.
Dean Q. Lin: “Convenient Care Clinics: Opposition, Opportunity and the Path to Health System
Integration.” Answer the two questions on page 168.
Short Case 12: Restructuring Wise Medical Center
Case 7: Reorganizing Primary Care at Blackwell Medical Center
Case 8: Future of Disease Management at Superior Medical Group
Herzlinger “Focused Factory” article in K&N, page 139-156 Text Reading Assignment: Griffin,
Chapters 6-10.
Discussion:
1. What is Herzlinger’s concept of focus?
2. What is her problem with the general or community hospital?
3. How important is design in creating a sustainable competitive advantage?
10/24 Lecture: Hospital Culture
Reading Assignment:
Collins and Porras. 1997. Built to Last: Successful Habits of Visionary Companies, Chapter 6,
“Cult-Like Cultures”.
Discussion:
1. Compare the culture of Hospital for Special Surgery (HSS) with that of Nordstrom.
2. How does HSS culture differ from that of typical hospitals?
3. How does Nordstrom and HSS perpetuate their culture?
FOCUS AREA: SUSTAINABLE COMPETITIVE ADVANTAGE
10/31 Lecture: Hospital strategic market management
Michael E. Porter, January 2009, “The Five Competitive Forces that Shape Strategy”.
How does the “Threat of New Entrants,” the “Threat of Substitute products and Services,” the
“Bargaining Power of Buyers,” the “Bargaining Power of Suppliers” and the state of “Rivalry
Among Existing Competitors” all affect hospital strategy? Compare and contrast these five
competitive forces at HSS and King Drew.
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Reading Assignment:
Harvard Case Study: Cincinnati Children’s Hospital
11/7 Lecture: Performance improvement
Reading Assignment:
Griffin: Chapters 23 and 24. Answer 5 of the 10 questions on page 282.
Brink, Susan. March 6, 2006. “And Now, Four Star Hospitals” in Los Angeles Times.
Discussion:
1. How do community hospitals discourage competition?
2. How did the veteran in Herzlinger’s chapter learn about hospital services in Thailand.
3. What was superior about the Thai experience?
11/14 Hospital visits or Student Presentations
11/21 Hospital visits or Student Presentations
11/28 Student Presentations; Final Examination review
12/5
Final Examination (Take Home).
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August 22, 2013
STUDENT INFORMATION SHEET
HCA 536; Fall 2013
(TURN IN TO INSTRUCTOR)
Name___________________________________________________________
Name you prefer to use____________________________________________
Address_________________________________________________________
Phone(s):________________________________________________________
Best time/place to reach you:_______________________________________
Fax:_________________________________________________________
E-mail address:__________________________________________________
Please describe briefly:
a. Your educational background and work experience:
b. Future educational and career plans:
c. Your reasons for taking this course, what you hope to learn from it:
d. Other HCA classes you are taking or have completed:
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